Effects of isosorbide mononitrate and AII inhibition on pulse wave reflection in hypertension

Gordon S. Stokes, Edward S Barin, Kerry L Gilfillan

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61 Citations (Scopus)


The aortic pulse wave contour in isolated systolic hypertension often shows a prominent reflection peak, which combines with the incident wave arising from cardiac ejection so as to widen pulse pressure. We investigated the effects of an extended-release nitrate preparation and of 2 angiotensin II (AII) inhibitors (an AII receptor antagonist and an ACE inhibitor) on the aortic pulse wave contour and systemic blood pressure in hypertensive subjects with high augmentation index caused by exaggerated pulse wave reflection. Two double-blind, randomized, placebo-controlled crossover studies were carried out in a total of 16 elderly patients with systolic hypertension resistant to conventional antihypertensive therapy. In 1 study, pharmacodynamic responses to single doses of placebo, isosorbide mononitrate, eprosartan, and captopril were determined; in the other, single-dose isosorbide mononitrate and placebo were compared in subjects treated with AII inhibitors at baseline. Blood pressure was measured by sphygmomanometry and pulse wave components by applanation tonometry at the radial artery. All 3 agents were shown to decrease brachial systolic blood pressure, aortic systolic blood pressure, and aortic pulse pressure. Qualitative effects on the aortic pulse wave contour differed: augmentation index was not significantly altered by either captopril or eprosartan but was decreased (P<0.0001) by approximately 50% of the placebo value with isosorbide mononitrate in both study groups. We propose that isosorbide mononitrate corrected the magnified wave reflection in systolic hypertension of these elderly patients by an effect that was distinct from that exercised by either acute or chronic AII inhibition.

Original languageEnglish
Pages (from-to)297-301
Number of pages5
Issue number2
Publication statusPublished - Feb 2003
Externally publishedYes


  • Acrylates
  • Aged
  • Aged, 80 and over
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Blood Pressure
  • Captopril
  • Cross-Over Studies
  • Delayed-Action Preparations
  • Double-Blind Method
  • Female
  • Heart Rate
  • Humans
  • Hypertension
  • Imidazoles
  • Isosorbide Dinitrate
  • Male
  • Middle Aged
  • Pulse
  • Thiophenes
  • Time Factors
  • Vasodilator Agents
  • Clinical Trial
  • Journal Article
  • Randomized Controlled Trial


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